Wauconda Pharmacy Inc

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

054006291 Issued in IL

Legal business name

WAUCONDA PHARMACY INC

Practice address

222 S Main St
Wauconda, IL 60084-1828

Phone

(847) 526-2591

Fax

(847) 526-1598

NPI assigned

Oct 25, 2006

Last updated

Nov 7, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Terry Bruner, RPHNPI 1407109077

Title

Owner

Phone

(847) 526-2591

Specialties & licenses 5

Addresses

Other identifiers 4

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Terry J Bruner, R.PH.

  • Pharmacist
  • Wauconda, IL
  • NPI 1407109077
  NPD (past) Authorized official
• Angela Beth Tobler, R.PH.

  • Pharmacist
  • Wauconda, IL
  • NPI 1275886848
  NPD (past)
• Alison Van Den Heuvel, PHARMD

  • Pharmacist
  • Wauconda, IL
  • NPI 1619220308
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1831274513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S MAIN ST",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600841828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S MAIN ST",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600841828",
            "telephone_number": "847-526-2591",
            "fax_number": "847-526-1598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUCONDA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2011-11-07",
        "status": "A",
        "authorized_official_last_name": "BRUNER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-526-2591",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "IL",
            "license": "054006291",
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PHARMACY",
            "identifier": "1428196",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "IL3147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "1428196",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362686883001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreens Boots Alliance
• Wauconda Cusd 118
• Wauconda Fire Department
• Wauconda Fire Protection District
• Wauconda Healthcare & Rehabilitation Centre, LLC
• Wauconda Pharmacy, Inc. (Vital Care of Wauconda)
• Wauconda Physical Therapy, Inc.
• Ahmad Wehbi
• Kelly Elizabeth Weller
• West Suburban Vision Care Inc.

• Compounding Pharmacy in Wauconda, IL
• Providers in Wauconda, IL by specialty
• Compounding Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.